Cartoon – Suffering in Silence
Category Archives: Silence
Michael Dowling: ‘Every single US hospital leader should be screaming about what an abomination this is’
Americans and global leaders have responded to the May 24 shooting at a Texas elementary school with heartbreak, anger and calls for change to better fight gun violence. But if you’re paying attention, the calls out of healthcare — from trauma surgeons, pediatricians, nurses, leaders and more — carry a distinct type of exasperation and sorrow.
“I’m in one of my hospitals now, sitting with some staff talking about it — it’s just so frustrating,” Michael Dowling, president and CEO of New Hyde Park, N.Y.-based Northwell Health, told me over the phone early Wednesday morning. “This does not represent what the United States stands for — that we allow people who should never be allowed to carry a gun to do so and walk into a school and kill fourth graders.”
The attack by a lone 18-year-old gunman at Robb Elementary School in the small town of Uvalde, Texas, has left at least 19 students and two adults dead. Students in the school, grades 2 through 4, were two days away from summer vacation.
Unlike many other known threats to our health, seeing the medical community condemn mass shootings still seems to leave some Americans doing a double take. It’s increasingly difficult to see what has them confused.
In 2016, the American Medical Association declared gun violence a public health crisis after a lone gunman killed 49 people and wounded 53 more in a mass shooting in a gay nightclub in Orlando, Fla. Even after the declaration, healthcare professionals and leaders continued to defy insistence from gun rights advocates that gun violence was not within their specialty or expertise. Or as the National Rifle Association put it in simpler terms in 2018: “Someone should tell self-important anti-gun doctors to stay in their lane.” The #ThisIsOurLane movement started then. The attempt to silence medical professionals ironically made their calls for action louder.
As healthcare professionals responded to the ongoing public health emergency of COVID-19, the arms race grew and gun buying intensified — “a surge in purchasing unlike anything we’ve ever seen,” as one gun researcher at the University of California, Davis, put it. People who already owned guns bought more, and people who had never owned a gun bought them too. In 2020, firearm-related injuries were the No. 1 cause of death of children and teens, according to the CDC.
Every day, 321 people are shot in the United States, and more than 40,000 Americans die from gun violence each year. Yet some healthcare executives still fear that taking the position that gun violence is a public health crisis will throw them into political turmoil given how toxic politics are in this country. It’s one position for the AMA and its 250,000-plus members to take, but another for an individual leader who may be the face of an organization in their community. There are risks of offending board members, donors, elected officials and other constituents — including patients. But here’s the thing: There will always be a reason to delay, to soften language, to wonder if this mass shooting is the one to react to.
Mr. Dowling urges his colleagues to step it up, noting how hospital and health system leaders can be ambassadors for gun safety in their communities, given the influence they wield as the largest employers in many communities.
“This is about protecting people’s health. This is about protecting kids’ lives. Have some courage. Stand up and do something,” he said. “Put the interest of the community in the center of what you think about each and every day. Our job is to save lives and prevent people from illness and death. Gun violence is not an issue on the outside — it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is.
“If you were hesitant about getting involved the day before May 24, May 24 should have changed your perspective. It’s time.”
Northwell established The Gun Violence Prevention Learning Collaborative for Health Systems and Hospitals, a grassroots initiative that gives healthcare professionals the space to have open dialogue about the impact of gun violence, share best practices and collectively take action. Learn more here.
How America’s massive COVID death toll came to feel “normal”
As the US approaches the grim statistic of one million deaths from COVID, journalist Ed Yong’s latest piece in The Atlantic takes a sobering look at how numb we’ve become to that astronomically high toll. In the early days of the pandemic, predictions of a few hundred thousand American deaths seemed shocking, but recent milestones of 800K and 900K lives lost have ticked by with little public attention.
Yong blames the invisibility of the virus: its worst impacts have been disproportionately concentrated among the disadvantaged—making it possible for COVID to more easily “disappear” from the lives of the healthy and economically advantaged. Case in point: while three percent of Americans have lost a close family member to COVID-19, the virus has taken a much larger toll on people of color, the elderly, and those with underlying health conditions.
The Gist: The pandemic has rendered us numb to the ongoing tragic loss of life, leading us to accept over 1,500 COVID deaths each day as “normal”.
As Yong points out, it’s hard to imagine we could turn a blind eye to this number of Americans perishing every day, compared to the number who perish from hurricanes or other weather disasters, for example. While permanent memorials are built for soldiers and victims of terror attacks, they are rarely erected for victims or medical heroes of pandemics, despite the far greater death toll.
While the pandemic is still far from over, we must ensure the difficult lessons learned are not forgotten by future generations—as has been the case with previous pandemics.
Importance of Silence
“It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”
~Mark Twain
Problem with Silence
US coronavirus data will now go straight to the White House. Here’s what this means for the world
Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.
For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.
On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.
Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.
Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”
The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.
In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.
Diminished role
When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.
This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.
As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.
The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.
The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.
But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.
“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”
What does it mean for the world?
The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.
Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.
This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.
The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.
This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.
It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.
What happens next?
Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.
In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.
COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.
Truth dies in silence. Sadly, so do people.
https://www.kevinmd.com/blog/2020/04/truth-dies-in-silence-sadly-so-do-people.html
I have been writing columns for physicians for twenty years. And year after year, I have had physicians say this: “I’m glad you said what you did. If I said it, I’d be fired.” There are variations on the theme, but they’re much the same. Twenty years, and far more than 20 years, during which the alleged health care leaders in America have been routinely muzzled because they aren’t supposed to speak the truth. Open discussions shut down because they might embarrass someone or upset an administrator. Because it might, heaven forbid, shine a light on a genuine problem.
Some years ago, as the mental health crisis was gathering steam across the emergency departments of the land, I was contacted by a news show in France. The producers wanted to come to South Carolina and follow me on some shifts in my ED. They wanted to see how mental health was working out here. “We have socialized care, but mental health is also a huge problem in our country,” the producer said.
I dutifully, and appropriately, went to administration. “No, we can’t do that,” I was informed. I was given this explanation when everyone knew the mental health system was at the breaking point: “What if they uncover a problem?” Here was a chance for publicity, for potential grant money or to demonstrate that a political solution was in order. How dare we let in fresh air? How dare we suggest that things were not perfect?
The same thing is happening in the midst of the pandemic. Physicians, nurses, and other assorted health care professionals are being threatened for wearing masks. Administrators say, “They make the patients nervous.” Also likely, administrators have realized they don’t have adequate equipment. Facilities and systems with enormous budgets caught unprepared in a pandemic.
I see the stories of these professionals as I follow online forums. Physicians, nurses, and others, threatened with firing because they dared to speak out on the issue of PPE (personal protective equipment).
Like police officers without ballistic vests, these physicians don’t want to go into the rooms of COVID-19 patients without the masks and respirators, gloves, gowns, and face shields that will keep them safe. The equipment that will allow them to return home to their loved ones and prevent them from infecting their families. This isn’t a good look. A hospital that refuses to acknowledge the concerns and safety of its professionals is a hospital that ultimately doesn’t deserve them.
The same veil of silence pervades dialogue on the treatment of coronavirus. When I follow discussions, I see a lot of shaming. “There just isn’t enough evidence to try hydroxychloroquine, Zithromax, convalescent plasma, an untried vaccine, HIV drugs, etc.” Those who suggest we might try are considered reckless or ignorant. As the battle rages and lives are lost, innovation and risk are viewed with disdain. And our medical establishment is locked into the paradigm of double-blinded, placebo-controlled studies involving tens of thousands of people and lasting years. Here’s a view of the same from the U.K. Unfortunately, to suggest that we may need to react faster is only met with ridicule, and often tied to political views instead of expediency. Worse, it ignores the deep, fundamental need to offer hope, any hope, to hundreds of millions of professionals and citizens who are living in fear.
There is a tragic irony here; a painful coincidence. Physicians silenced. Let’s see. Where did we see that sort of thing resulting in a worldwide pandemic? Does China come to mind? The Chinese Communist Party threatened (and who knows what else) physicians who dared to speak out about coronavirus, even when they knew its danger. Even when they knew how easily and widely it spread.
They continued to soft-peddle numbers about total cases and case fatality. The party continued to allow travel to and from China long after the problem was known. They even suggested that Italians have a “hug a Chinese person” campaign to combat alleged racism; a charge delightfully accepted and repeated by gullible Western journalists in pursuit of a narrative.
Truth dies in silence. Sadly, so do people. And certainly when we tell dedicated health care professionals to keep their mouths shut when they have identified problems, offered solutions and simply asked for help. Whether it’s a private business, a totalitarian government, or anything in between, we should insist that the truth be spoken; freely and without fear of punishment.
Because, for the foreseeable future, lives will depend on it.
HENRY KOTULA 